Should You Give Birth at a Birth Center? (Published 2018) (2022)

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Should You Give Birth at a Birth Center? (Published 2018) (1)

By Alice Callahan

(Video) RAW NO EPIDURAL LABOR DELIVERY LIVE BIRTH VLOG | 29 HOURS OF LABOR & WHAT ACTUALLY HAPPENS | BABY #4

When Gillian Tarr became pregnant with her second child, she chose a free-standing birth center in Seattle for her prenatal care and delivery. Her first baby had been born in a hospital, and while it was a relatively uncomplicated birth, she felt dissatisfied with the care she received.

“It was impersonal and lacked any real support,” said Dr. Tarr, an epidemiologist now living in Calgary, Alberta.

For example, four different obstetricians cared for her during her hospital stay, none of whom she’d met before. During labor, the required fetal monitoring device around her belly often needed adjusting, including in the middle of contractions, and that disrupted her attempts to cope with the pain, as did the strangers regularly coming and going from her room.

Her birth center experience was completely different. “I knew everyone in the room. They were helpful when I needed them and unobtrusive when I didn’t,” she said.

Neither homes nor hospitals, birth centers claim to offer the best of both worlds: midwifery care in a homelike environment, with basic equipment on-site and a plan to transfer to the hospital if necessary.

Nearly 20,000 babies in the United States were born at free-standing birth centers in 2016, an 83 percent increase over the previous decade, based on data from the Centers for Disease Control and Prevention. Not included in those numbers are birth centers located within hospitals, often midwife-led and separate from the main labor and delivery ward.

For women in the United States with low-risk pregnancies, birth centers can offer an alternative to the typically expensive and intervention-heavy maternity care system. Birth centers don’t do cesarean deliveries, but among women in birth center care, about 6 percent of them end up with a C-section after transferring to a hospital; that’s far lower than the 26 percent of low-risk pregnancies over all that are delivered by C-section. Plus, the cost of a birth center delivery is roughly half that of an uncomplicated hospital birth (often paid for by insurers, including Medicaid).

The birth center model of care emphasizes personal attention and familiarity, including longer prenatal visits and continuous support from a midwife through labor. Many also provide home visits and breast-feeding counseling in the postpartum period.

“Creating a place where both the environment and the people are familiar to the laboring woman, I believe, has an impact on their ability to cope in labor,” said Nora Tallman, a certified nurse midwife at the Midwifery Birth Center in Portland, Ore., whose 32-year career has also included home birth and hospital midwifery.

At a birth center, you have “privacy, intimacy, agency and freedom of movement,” said Jennie Joseph, a midwife and owner of a birth center called the Birth Place in Winter Garden, Fla. You won’t be tied to monitoring equipment during labor, and you’re free to eat and drink and have lots of friends and family in the room if you like, all of which may be restricted in a hospital, she said.

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Good candidates

Birth centers aren’t equipped to handle complicated births or to provide epidural anesthesia. The American Association of Birth Centers says that appropriate low-risk candidates include singleton pregnancies (no twins) that are full term with the baby’s head down (not breech). Mothers should also be free of other medical conditions like insulin-dependent diabetes or high blood pressure. In addition, most birth centers won’t accept women who have previously had a C-section because of the increased risk that the uterine wall might rupture on the cesarean scar, a rare but life-threatening emergency requiring fast access to an operating room.

Birth centers offer lots of other ways of coping with pain besides an epidural, like a warm bath, massage and encouragement from a midwife. Some also offer IV pain medications or nitrous oxide, but the emphasis is on supporting women who want an unmedicated birth.

That was a major reason Breesa Collyer drove two hours from her home in Pleasanton, Calif., to a hospital-affiliated birth center in Davis for both of her sons’ births. “I wanted confidence that everyone around us had the same goals that we did,” she said.

But labor can be long and unpredictably painful. Dr. Steve Calvin, an obstetrician and medical director of the Minnesota Birth Center in Minneapolis and St. Paul, says about one in four to one in five first-time moms at their centers end up transferring to the hospital during labor for an epidural. Both of their centers are close to hospitals — one across the street and the other a mile away.

“It’s not a failure,” Dr. Calvin tells his patients. “You may need an epidural, and that epidural may give you the relief you need to accomplish a vaginal birth.”

Safety concerns

Most births can happen safely outside of a hospital, especially if women have been appropriately screened as low-risk and they’re cared for by experienced midwives. But birth can also take a terrifying turn, for both mother and baby, and if you run into complications in a birth center, you’re farther from the medical resources a hospital can provide.

But for low-risk births, research shows birth centers can be just as safe as hospitals. In England, where midwife-led birth centers are an integrated part of maternity care in the National Health Service, a study of 65,000 births found that those in birth center care were less likely to have a C-section, forceps or vacuum delivery, or episiotomy, and they had no increased risk of mortality or major complication compared to hospital births.

Research from the United States is similarly positive, but it comes with an important caveat. The largest contemporary study was based on data voluntarily submitted by birth centers and represented just 32 percent of birth centers in the United States at the time.

Birth centers “with great outcomes probably are reporting what they’re doing, and then people who don’t have great outcomes or get shut down or run out of money or whatever — we just don’t know what they’re doing,” said Dr. Victoria Woo, an OB-GYN and research fellow at Stanford’s Clinical Excellence Research Center.

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(Video) What's in My Birth Center Bag? | Natural Labor & Delivery

The medical system in the United States — and birth centers’ place in it — is also different from that in Britain. Most birth centers in the United States are privately owned businesses with their own protocols for identifying whether a higher level of care is needed and how the transfer is carried out.

Sometimes birth centers “have a comfortable agreement with the nearby hospitals and midwives have privileges there, and that’s fine,” said Dr. Woo, who has advocated for improved integration of birth centers. “Other times, they have no relationship, and then that often is what leads to bad outcomes, because there will be delays in transfer of care,” she said.

In the United States, about 22 percent of women planning to give birth at a birth center end up transferring to a hospital during labor or soon after giving birth with 2 percent being emergency situations.

Unfortunately, Dr. Tarr was one of these. She unexpectedly hemorrhaged after her daughter was born and had to go by ambulance to a hospital. It was scary, but she got appropriate medical attention in time, and the admitting nurse told her that the midwife had done everything right. Still, Dr. Tarr isn’t sure she would choose a birth center if she had another child. “I am happy with the birth experience I had there, but I am also more scared of what can happen, with no warning, even if you’re low risk.”

Giving birth outside of a hospital doesn’t mean it’s more dangerous, said Dr. Calvin, who specialized in high-risk obstetrics for 25 years before opening a birth center.

Wherever you give birth, your safety depends on what Dr. Calvin calls your “perinatal safety net.” How far are you from an operating room, an anesthesiologist, a blood bank, if something catastrophic happens? Consider that distance in miles, in minutes, and in the vigilance of the people you’ve trusted with your care. Ideally, a birth center should be within 10 to 15 minutes of a hospital, with a well-defined plan for transport, he said.

Dr. Calvin also points out that access to these medical resources is not a given in the United States, even in hospitals. A California study found that just 50 percent of community hospitals had 24-hour anesthesia availability and only 56 percent could perform an emergency C-section within 30 minutes.

“The ideal is to have support for natural birth and a robust safety net that finds the sweet spot between obstetric care that is ‘too much, too soon’ and ‘too little, too late,’” Dr. Calvin said.

What to Ask When Considering a Birth Center

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(Video) Should you switch to a birth center? - Q&A with Eastside Birth Center Midwives

If you’re considering a birth center, start by asking about licensing and accreditation. Most states license birth centers as health care facilities, but some have stricter requirements than others, and nine states don’t license or regulate birth centers at all.

Birth centers can also apply for accreditation from the Commission for the Accreditation of Birth Centers, which relies on national quality standards. However, only about a third of birth centers are currently accredited.

If a birth center isn’t licensed and accredited, ask why it isn’t, and know that this means there’s less scrutiny and oversight for its practices.

You should also ask about the center’s criteria for accepting patients. “If they’re willing to take anybody, that’s asking for trouble,” Dr. Calvin said. His center has a published list of criteria.

Ask about the plan for transfer, including what your midwife’s role will be if you go to a hospital. Certified nurse midwives can have hospital privileges so may still be able to continue to care for you in the hospital, whereas certified professional midwives do not. Yours may be able to stay with you, but not as a health care provider.

Visit the birth center, take a tour, ask lots of questions, and see how it feels. “Do you have that sense of comfort?” Ms. Joseph asked. “If you walk in the door and you don’t feel right, then that’s not you. That’s not your birth center.”

Alice Callahan, a writer in Eugene, Ore., is the author of “The Science of Mom: A Research-Based Guide to Your Baby’s First Year.”

FAQs

What are the disadvantages of a birthing center? ›

What are the downsides of giving birth at a birth center?
  • Lack of centers. The number of birth centers around the country is limited (and services may be in high demand) — especially if you live in a small town.
  • Possible transfer to a hospital. ...
  • Your insurance may not cover it. ...
  • They're not for everyone.
30 Mar 2021

Are birthing Centres safe? ›

Having your baby in a birth centre is no more or less risky than in hospital (Hollowell et al 2011), although you are less likely to need an assisted birth in a birth centre. If you're a first-time mum, having your baby at a birth centre is slightly safer than giving birth at home.

What percent of births take place in hospitals? ›

Hospitals are the most common place of birth in the United States, with 98.4 percent of births taking place in a hospital in 2017 (MacDorman and Declercq, 2019).

What are the benefits of a birthing Centre? ›

Advantages of a midwifery unit or birth centre

being more likely to be looked after by a midwife you have got to know during your pregnancy. the unit potentially being much nearer your home. lower likelihood of having an intervention such as forceps or ventouse than giving birth in hospital.

Why birthing centers are better than hospitals? ›

Birthing centers allow mothers to progress through the birthing process at their own pace and in the mother's preferred positions. Typically, more family members are allowed to be with the mother during labor process. Birthing centers have shorter stay times after birth compared to a hospital setting.

What are the advantages and disadvantages of birth centers? ›

The advantages of a hospital birth include pain control, access to a NICU, staff support, and availability of interventions. Disadvantages include stress, fewer birthing positions, fewer support people, and you may not be able to choose your delivery doctor.

Can you have an epidural in a birthing Centre? ›

Alongside birth centres are on the same sites as hospital labour wards. That means you can be transferred easily if you do want an epidural (Which?, 2018). If you're not in an alongside unit, you can be transferred from any midwife-led unit or birth centre to hospital for an epidural too.

Are you allowed 2 birthing partners? ›

You are welcome to bring up to two birthing partners to be with you in The Birthing Centre and one birth partner if you plan to give birth on the Labour Ward.

What is the difference between birth center and Labour Ward? ›

Birth centres can be alongside but separate from a hospital labour ward. They can also be in a different place completely so they're freestanding. Birth centres don't have obstetric, neonatal or anaesthetic care on the premises. As with labour wards, all midwife-led units are different.

Are home births safer than hospital births? ›

Most pregnant people who choose to have planned home births deliver without problems. But research suggests that planned home births are associated with a higher risk of infant death, seizures and nervous system disorders than planned hospital births.

When did it become common to give birth in a hospital? ›

1920′s : Births moved from home into hospitals for those that could afford it and those who would like medication during childbirth. “Twilight Sleep” is introduced in the United States, although it has been widely used in Europe for about 20 years.

What is the most common way to give birth in the US? ›

Vaginal delivery is the most common type of birth. When necessary, assisted delivery methods are needed. While labor can be a straightforward, uncomplicated process, it might require the assistance of the medical staff.

What is an advantage of having a baby in an alternative birthing center over a standard hospital delivery? ›

What is an ADVANTAGE of having a baby in an alternative birthing center over standard hospital delivery? Lower cost for the delivery of the baby.

What are two cons to having a family doctor deliver a baby? ›

At the same time, there are a few major drawbacks to a family practice physician for some people: Less specific focus on child care. Can be less comfortable for kids. Some won't take children under a certain age.

Are hospital births better? ›

That's not a surprise: The American College of Obstetricians and Gynecologists, or ACOG, recommends hospitals or accredited birth centers as the safest option for having a baby. In fact, infant mortality plummeted in the past century as hospital births became more common.

What are the pros and cons of home delivery? ›

Here are the pros and cons of using a delivery service:
  • Pro: You'll save time.
  • Con: Convenience comes at a cost.
  • Pro: You'll have added time for other tasks.
  • Con: You still may need to go to a physical store or branch.
2 Jul 2019

What is the percentage of home births in the US? ›

Results—The percentage of home births in the United States rose from 1.03% (38,506) in 2019 to 1.26% (45,646) in 2020, an increase of 22% and the highest level since at least 1990.

Who should be there when you give birth? ›

Davis adds that you are typically allowed to have one support person in addition to a partner. While some women will choose to have a doula or labor coach there for support, others might invite a parent or additional family member. Regardless of who you invite into the delivery room, Dr.

Do birth centers use Pitocin? ›

Synthetic oxytocin (“Pitocin”) is not used in birth centers to speed up labor. Skillful midwives know many drug-free ways to promote labor progress.

Is water birth better? ›

Studies show water birth during stage one doesn't improve your or your baby's medical outcome. A warm bath might help you relax and help you feel more in control. Floating in water helps you move around more easily than in bed, too. Some science suggests that the water may lower chances of severe vaginal tearing.

What are the advantages of a freestanding birth center? ›

Advantages of a freestanding birth center

Avoid a cesarean section. The national c-section rate for freestanding birth centers is 6 percent, compared with 32.7 percent for low-risk women in the hospital. Water birth. All freestanding birth centers offer water immersion in labor, and most (93 percent) offer water birth.

What pain relief can you have with water birth? ›

What other pain relief can I have in the water? Water is sometimes referred to as 'nature's epidural' or 'aquadural', because of the support and pressure it gives you. However, if you need a little extra, it is common to use gas and air (Entonox) while you are in the birth pool.

How can I get labour pain free? ›

Medicine-free ways to handle pain during labor include:
  1. hypnosis.
  2. yoga.
  3. meditation.
  4. walking.
  5. massage or counterpressure.
  6. changing position.
  7. taking a bath or shower.
  8. listening to music.

How long is the average labour? ›

In a 1st labour, the time from the start of established labour to being fully dilated is usually 8 to 12 hours. It's often quicker (around 5 hours), in a 2nd or 3rd pregnancy. When you reach the end of the 1st stage of labour, you may feel an urge to push.

Can my partner stay with me overnight in hospital after birth? ›

Partners are not allowed to stay overnight. No children are allowed to visit, including siblings.

Should I wear a mask around newborn? ›

Wear a mask when within 6 feet of your newborn and other people during your entire isolation period. The mask helps prevent you from spreading the virus to others.

Can partner stay overnight after C-section? ›

During a c-section

You can usually stay with your partner during a planned or emergency c-section unless they need a general anaesthetic.

Can I change hospitals during pregnancy? ›

Should you wish to change maternity providers, you will need to inform your current named midwife who will notify the maternity provider where you now wish to give birth. In most cases this will involve a new booking appointment and your named midwife and maternity team are likely to change.

How much does it cost to give birth in America? ›

The average cost of child birth in the US is $18,865.

What do I do if I give birth at home? ›

How to deliver a baby at home by yourself
  1. Call 911. ...
  2. Unlock your door so the medical crew can open it. ...
  3. If your partner isn't there with you, call a neighbor or nearby friend.
  4. Call your doctor or midwife. ...
  5. Grab towels, sheets, or blankets. ...
  6. Take off your pants and underwear.
  7. Lie down or sit propped up. ...
  8. Try to stay calm.

How many planned home births end up in hospital? ›

Distressing as it might be, this is not an unusual outcome for home births: around 40% of first-time mothers who plan to deliver their child at home end up being transferred to hospital.

Do home births have a higher mortality rate? ›

Among women who originally intend to give birth in a hospital or those who make no provisions for professional care during childbirth, home births are associated with high rates of perinatal and neonatal mortality 3.

What is considered high risk pregnancy? ›

A "high-risk" pregnancy means a woman has one or more things that raise her — or her baby's — chances for health problems or preterm (early) delivery. A woman's pregnancy might be considered high risk if she: is age 17 or younger. is age 35 or older.

When did doctors start delivering babies instead of midwives? ›

More physicians in the late 19th century (which at that time also meant more men) were becoming involved in obstetric care and were replacing midwives, who were mostly women. In addition, women began to give birth in hospitals and the proportion of women doing so steadily increased throughout this period.

When did babies stop being born at home? ›

Trends. Home birth was, until the advent of modern medicine, the de facto method of delivery. In many developed countries, home birth declined rapidly over the 20th century. In the United States there was a large shift towards hospital births beginning around 1900, when close to 100% of births were at home.

When did midwives stop home visits? ›

The most significant change took place in 1973 when, for the first time, the Chair of the CMB was a midwife. This was short lived, however, as the Nurses, Midwives and Health Visitors Act (1979) ended the CMB, moving the locus of control of midwifery from doctors to nurses.

What is a Lotus baby? ›

A lotus birth is the decision to leave your baby's umbilical cord attached after they are born. The umbilical cord remains attached to the placenta until it dries and falls off by itself.

Is it better to give birth squatting? ›

Preparation. Squatting is beneficial because it tilts the uterus and pelvis forward, placing the baby in proper alignment for delivery. Squatting also encourages and strengthens the intensity of contractions, and can also relieve pressure in the back.

What is more painful C-section or natural birth? ›

However, recovery from a cesarean delivery is generally more painful. “[It] is a lot more painful, longer, and often more difficult than recovery from a vaginal birth because it is a major abdominal surgery,” Teen explains.

What are two disadvantages of birth centers? ›

What are the downsides of giving birth at a birth center?
  • Lack of centers. The number of birth centers around the country is limited (and services may be in high demand) — especially if you live in a small town.
  • Possible transfer to a hospital. ...
  • Your insurance may not cover it. ...
  • They're not for everyone.
30 Mar 2021

What are the advantages and disadvantages of hospital birth centers home births? ›

The advantages of a hospital birth include pain control, access to a NICU, staff support, and availability of interventions. Disadvantages include stress, fewer birthing positions, fewer support people, and you may not be able to choose your delivery doctor.

Why birthing centers are better than hospitals? ›

Birthing centers allow mothers to progress through the birthing process at their own pace and in the mother's preferred positions. Typically, more family members are allowed to be with the mother during labor process. Birthing centers have shorter stay times after birth compared to a hospital setting.

Why would someone choose a midwife over an OB? ›

You have control over your birth plan

Many women choose to use a midwife because it gives them more options for their birth plan. You have more control over your birthing experience, from where you choose to deliver your baby to the type of drug interventions you're comfortable using.

Are midwives better than Obgyn? ›

High-risk vs. low-risk pregnancies – OB-GYNs can manage high-risk or complicated pregnancies such as women who are expecting twins or have preexisting medical conditions. Midwives, on the other hand, can manage low-risk pregnancies and births.

Why choose a midwife over a doctor? ›

Many women choose a midwife over a doctor because they want additional emotional support before, during and after delivery. A midwife will get to know you, your family and your preferences over the course of your pregnancy.

Are home births statistically safer? ›

(Reuters Health) - Newborns in the U.S. are much more likely to survive a hospital delivery than a planned home birth, regardless of how qualified the attending midwife may be, a new study suggests.

Is it safer to give birth at home or in a hospital? ›

In their analysis, the risk of a baby's dying was low in each setting, but higher among the group that intended home delivery: 1.8 per 1,000 for planned in-hospital births as compared with 3.9 per 1,000 for planned out-of-hospital births.

Are home births statistically safer than hospital births? ›

Compared with US hospital births attended by a certified nurse-midwife, planned US home births for all types of attendants are a less safe setting of birth, especially when recognized risk factors are taken into account.

Why are home births not always recommended? ›

Most pregnant people who choose to have planned home births deliver without problems. But research suggests that planned home births are associated with a higher risk of infant death, seizures and nervous system disorders than planned hospital births.

What is an advantage of having a baby in an alternative birthing center over a standard hospital delivery? ›

What is an ADVANTAGE of having a baby in an alternative birthing center over standard hospital delivery? Lower cost for the delivery of the baby.

What are the pros and cons of home delivery? ›

Here are the pros and cons of using a delivery service:
  • Pro: You'll save time.
  • Con: Convenience comes at a cost.
  • Pro: You'll have added time for other tasks.
  • Con: You still may need to go to a physical store or branch.
2 Jul 2019

Should I give birth at a hospital? ›

You should give birth in a hospital if:

You have a medical issue, such as high blood pressure or diabetes, that makes your pregnancy higher risk. You've had a premature birth, a cesarean delivery (c-section), or other complicated delivery before. You are pregnant with more than one baby, such as twins or triplets.

What problems do you face in private hospitals? ›

Private hospitals are not owned or controlled by the government.
...
Problems faced by Aman
  • Non-availability of doctors.
  • Junked and non-operational equipment.
  • Non-availability of medicines.
  • Crowded.
  • The indifference of doctors etc.
  • Proper and strict administration can get the hospital's work in a better manner.
24 Jul 2021

What happens during a traditional hospital birth? ›

Traditional hospital births are still the most common option. This means the mother-to-be moves from a labor room to a delivery room and then, after the birth, to a semiprivate room. In a hospital birth: Pain medicines are available during labor and delivery, if a woman wants them.

What percentage of home births are successful? ›

Of first-time moms choosing home birth, up to 37 percent transfer to a hospital, largely because the baby is unable to move through the birth canal. Planned home births end up with fewer cesarean deliveries (53 births per 1000 compared to 247 per 1000 hospital births).

Is it safer to give birth at home or in a hospital? ›

In their analysis, the risk of a baby's dying was low in each setting, but higher among the group that intended home delivery: 1.8 per 1,000 for planned in-hospital births as compared with 3.9 per 1,000 for planned out-of-hospital births.

What if you tear during a home birth? ›

For most women, these tears are minor and heal quickly. If you need stitches for a tear or episiotomy after you've had your baby, your midwife will probably be able to do those in your home. If you have a serious tear, you'll be transferred to hospital.

Can you have an epidural in a birthing Centre? ›

Alongside birth centres are on the same sites as hospital labour wards. That means you can be transferred easily if you do want an epidural (Which?, 2018). If you're not in an alongside unit, you can be transferred from any midwife-led unit or birth centre to hospital for an epidural too.

What is the difference between birth center and Labour Ward? ›

Birth centres can be alongside but separate from a hospital labour ward. They can also be in a different place completely so they're freestanding. Birth centres don't have obstetric, neonatal or anaesthetic care on the premises. As with labour wards, all midwife-led units are different.

What are two cons to having a family doctor deliver a baby? ›

At the same time, there are a few major drawbacks to a family practice physician for some people: Less specific focus on child care. Can be less comfortable for kids. Some won't take children under a certain age.

How long do you have to stay in the house after giving birth? ›

If you have a straightforward vaginal birth in a public hospital or birthing centre, you'll probably go home within 24 hours. A midwife might visit you at home. If you have your baby in a private hospital, you might be able to stay longer, if you want to.

Would you consider a home birth or recommend it to others? ›

Some research has found that planned home births are associated with a higher risk of infant death or severe injury than births planned at hospitals. For this reason, neither the American College of Obstetricians and Gynecologists (ACOG) nor the American Academy of Pediatrics (AAP) currently recommends home birth.

Can you give birth without pain? ›

Having no pain during labor was very or somewhat important to women who chose medical methods (epidural, medication delivered through an IV or injection, spinal block or nitrous oxide) only (79 percent) compared to women who opted for complementary methods (breathing, water birth, massage, visualization or hypnosis) ...

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